Management of ventilator associated pneumonia with a new antibiotic adjuvant entity (ceftriaxone+sulbactam+disodium edetate) - A novel approach to spare carbapenems

• Published in: Journal of critical care Vol. 41; pp. 145 - 149
• Main Authors: Sathe, Prachee, Maddani, Sagar, Kulkarni, Shilpa, Munshi, Nita
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2017; Elsevier Limited
• Subjects: A. baumannii; Acinetobacter baumannii - drug effects; Acinetobacter baumannii - isolation & purification; Acinetobacter Infections - drug therapy; Adult; Aged; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic adjuvant entity; Antibiotics; Bacterial infections; Carbapenem; Ceftriaxone - administration & dosage; Chemotherapy, Adjuvant; Colistin - therapeutic use; Costs; Critical care; Cross Infection - drug therapy; Drug dosages; Drug resistance; Drug Therapy, Combination; Edetic Acid - administration & dosage; Epidemiology; Female; Hospitalization; Humans; Infections; Intensive Care Units; Male; Microbial Sensitivity Tests; Middle Aged; Mortality; Multi-drug resistant microorganisms; Patients; Pneumonia; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - economics; Pneumonia, Ventilator-Associated - microbiology; Retrospective Studies; Sulbactam - administration & dosage; Thienamycins - administration & dosage; Ventilator associated pneumonia; Ventilators; Carbapenem; Ventilator associated pneumonia; Antibiotic adjuvant entity; Multi-drug resistant microorganisms; A. baumannii
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2017.04.002

Ventilator associated pneumonia (VAP) is one of the most serious nosocomial infections in Intensive Care Unit (ICU). The aim of this study was to evaluate a new approach to spare the carbapenems for the management of patients diagnosed with VAP due to Acinetobacter baumannii (A. baumannii).
This retrospective study was conducted on VAP patients presenting for treatment at tertiary care centre between May 2014 and March 2016. The case sheets of patients who have been treated for VAP with meropenem, antibiotic adjuvant entity (AAE) and colistin were analysed.
Out of 113 patients analysed, 24 (21.3%) patients were having VAP due to MDR A. baumannii. Microbial sensitivity has shown that 87.5% of patients were sensitive to AAE and colistin whereas all of them were resistant to meropenem, imipenem and gentamycin. The mean treatment durations were 12.4±2.1, 13.2±2.4 and 14.3±2.1days for AAE, meropenem+colistin and AAE+colistin treatment groups. In AAE susceptible patients, the mean treatment duration and cost could be reduced by 23–24% and 43–53% if AAE is used empirically. In AAE-resistant patients, the mean treatment duration and cost could be reduced by 21% and 26% if AAE+colistin regime is used empirically instead of meropenem followed by AAE+colistin.
Clinical assessment with microbial eradication and pharmaco-economic evaluation clearly shows benefits in using AAE empirically in the management of A. baumannii infected VAP cases.
•A retrospective study conducted on subjects suffering from ventilator associated pneumonia due to A. baumannii.•87.5% were sensitive to AAE and colistin whereas all of them were resistant to meropenem, imipenem and gentamycin.•The treatment duration and cost could be reduced by 23-24% and 43- 53% if AAE is used empirically.